Clinicoradiological Images of a Rare Type of Lumbar Hernia

A surgeon will rarely see a case of lumbar hernia in his lifetime. They are usually divided into superior and inferior types, but in cases of huge hernias where anatomical delineation is not possible, they are called as diffuse. Further classification into primary and secondary types (on the basis of etiology) and congenital and acquired types is done. Evisceration in a lumbar hernia can be present due to secondary causes but never spontaneously. This is therefore probably the first reported case of a primary eviscerated diffuse lumbar hernia.     

Laparoscopic management of inferior lumbar hernia (Petit triangle hernia)

Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8×10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.     

Primary lumbar hernia: A rarely encountered hernia

IntroductionLumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option.Presentation of caseA 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. He had noticed a swelling over the left side of his mid-back and consequently on examination was found to have a primary acquired lumbar hernia arising from the deep superior lumbar triangle of Grynfelt. Diagnosis was confirmed by Computed Tomographic imaging.DiscussionA lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome.ConclusionA surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.     

Laparoscopic Repair of Left Lumbar Hernia After Laparoscopic Left Nephrectomy

Lumbar hernias, rarely seen in clinical practice, can be acquired after open or laparoscopic flank surgery. We describe a successful laparoscopic preperitoneal mesh repair of multiple trocar-site hernias after extraperitoneal nephrectomy. All the key steps including creating a peritoneal flap, reducing the hernia contents, and fixation of the mesh are described. A review of the literature on this infrequent operation is presented. Laparoscopic repair of lumbar hernias has all the advantages of laparoscopic ventral hernia repair.     

腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效

目的探讨腹腔镜下腹腔内补片植入修补法治疗获得性腰疝的临床疗效,为获得性腰疝的治疗提供相对合理的方案。 方法2015年1月至2018年6月,首都医科大学附属北京中医医院共对47例获得性腰疝的患者采用腹腔镜下腹腔内补片植入修补法进行治疗,记录患者手术前后的临床参数,观察并分析术后并发症及复发情况。 结果47例患者均经腹腔镜顺利完成手术,手术时间100～180 min,平均134 min;术中出血量80～140 ml,平均110 ml;术后住院时间5～14 d,平均7 d。术后出现浆液肿2例,经穿刺抽液后给予腹带包扎处理后治愈;腹胀4例,均于5 d内自行缓解;肠梗阻1例,于术后第13天治愈;术区疼痛不适10例,给予止痛药治疗后缓解;戳孔感染2例,给予积极换药处理后治愈;患者术后均未出现肠瘘、腹腔感染、戳孔血肿、戳孔疝、慢性疼痛等严重并发症。随访时间6～48个月,均未出现疝复发。 结论获得性腰疝修补采用腹腔镜下腹腔内补片植入修补法进行治疗,目前是一种有效且安全、可行的治疗方法,可促进患者快速康复,降低相关并发症的发生及疝的复发,值得临床进一步推广。     

Totally extraperitoneal laparoendoscopic repair of lumbar hernia

Background: The repair of congenital and acquired lumbar hernias has remained a significant surgical challenge for over three centuries. Transperitoneal laparoendoscopic techniques have been reported that have achieved success in repairing these difficult hernias using a variety of synthetic mesh. Careful review of the surgical literature addressing the repair of lumbar hernia reveals that only fourteen successful cases have been reported using minimally invasive techniques. All of these cases elected a transperitonal approach to repair. Encouraged by established success in the repair of inguinal hernia using an extraperitoneal approach, the repair of a large inferior triangle lumbar hernia was attempted using overlapping synthetic mesh technique while remaining entirely in an extraperitoneal plane. Methods: A seventy-eight-year-old patient presented for repair of a large symptomatic right lumbar hernia, one year following iliac bone harvest for lumbar laminectomy/fusion. Under general anesthesia, the patient was placed in a lateral decubitus position with lumbar roll in place. Using a muscle splitting dissection through the lateral abdominal musculature, a plane was developed bluntly between the transversalus muscle and the peritoneum. Using a three trocar technique, the plane was matured posteriorly, achieving an ample working space to identify the hernia and complete a synthetic mesh (PTFE) repair. Results: A large inferior triangle lumbar hernia was successfully repaired using overlapping synthetic mesh technique while remaining entirely in an extraperitoneal plane. Eighteen month reevaluation including physical examination and computer tomographic (CT) study confirms successful repair without recurrence of symptoms. Conclusions: A totally extraperitoneal approach to the identification, mobilization, and repair of lumbar hernia can be successfully accomplished using established laparoendoscopic surgical techniques.     

Laparoscopic management of lumbar hernia

We describe (for the first time) a laparoscopic approach to repair an acquired superior triangle lumbar hernia in a morbidly obese woman by using prosthetic mesh. Such a technique provides an excellent anatomic view, thus avoiding injury to structures in proximity to the hernia during repair; eventually the well-known advantages of such approach result. Received: 10 November 1996/Accepted: 20 December 1996     

小切口Stoppa修补术治疗老年性腰疝18例分析

目的探讨老年性腰疝的病因及小切口腹膜前疝修补术(Stoppa术)治疗腰疝的临床效果。方法对Stoppa修补术治疗的18例老年腰疝患者的临床资料进行回顾性分析。18例患者中有肾脏或腰椎手术史10例,腰部外伤史3例,垂体瘤切除史1例,无明确外伤或手术史4例。18例患者中有腹压增高病史9例。本组均采用全麻小切口Stoppa修补术。结果切口长度平均8.5(6～10)cm,手术时间平均30.1(25～50)min。术后住院时间平均4.5(3～6)d。术后发生浆液肿1例,2周后自行吸收,无切口明显疼痛或切口感染,无围手术期死亡病例。本组患者均获随访,平均21.1(3～50)个月,未见疝复发及切口慢性疼痛。结论老年性腰疝多为后天获得性,发病与腹压增高、肾脏或腰椎手术及外伤等因素有关。小切口腹膜前疝修补术(Stoppa修补术)是一种开放式经前入路腹膜前修补的微创手术,具有操作简便、安全有效、经济实用等优点,尤其适合老年性巨大腰疝的治疗。     

Retroperitoneoscopic tension-free repair of lumbar hernia

Lumbar hernia is an infrequent pathology that is difficult to treat through open surgery. A 65-year-old man presented with a right-sided lumbar mass responsible for pain. This was a fatty mass of 10×15 cm, located in the lumbar fossa. A CT scan showed the hernia and the defect. Through a small incision in the flank, dissection was initiated with one finger; a 10-mm trocar was inserted into this incision and the retroperitoneal space inflated. Under direct vision, dissection of retroperitoneal fat was undertaken with the scope. A 5-mm trocar was inserted beyond the 11^th rib. Fat in the lumbar hernia was reintegrated into the retroperitoneal space, allowing the lumbar wall defect to be seen. A polypropylene mesh was applied and stapled onto the lumbar wall to widely cover the defect. Under trans-abdominoretroperitoneal laparoscopy, lateral peritoneum, colon, and ureter are detached to explore the lumbar wall and are reinserted at the end of the procedure. Under retroperitoneoscopy, even if the space is small, retroperitoneal fat is easily detached at a distance from the colon and ureter. The defect is covered with a polypropylene mesh. It is covered with an ePTFE mesh if the retroperitoneal space cannot be closed. Surgery and follow-up were uneventful with no recurrence in this case or in the published cases. Retroperitoneoscopy and trans-abdominoretroperitoneal laparoscopy are two easy approaches for a tension-free repair of lumbar hernia.     

破裂型腰椎间盘突出症85例临床分析

手术治疗348例腰椎间盘突出症，85例确诊为破裂型，占24．4％。根据病史、腰腿痛程度、直腿抬高试验阳性角度及CT等综合分析，认为本前可诊断破裂型椎间盘突出症。CT扫描的髓核脱出率、后突角和硬膜囊脂肪阴影的消失有诊断价值。一旦诊断破裂型椎间盘突出症宜及早手术。     

腰疝10例诊治分析

目的 探讨腰疝的临床表现、诊断和治疗方法.方法 对1999年10月～2008年10月间收治的有完整资料的10例腰疝病例进行回顾性分析.结果 临床表现为腰背部可复性肿块、腰背部疼痛不适、恶心、呕吐,由上腰三角突出9例,由下腰三角突出1例.10例均经多普勒超声协助诊断.10例均行手术治疗,3例利用自身组织缝合修补,7例使用人工补片修补.结论 临床表现和体征是诊断腰疝的关键,彩色多普勒超声是腰疝首选的辅助诊断方法,外科手术是治疗腰疝的有效手段.     

腰疝10例诊治分析

目的探讨腰疝的临床表现、诊断和治疗方法。方法对1999年10月～2008年10月间收治的有完整资料的10例腰疝病例进行回顾性分析。结果临床表现为腰背部可复性肿块、腰背部疼痛不适、恶心、呕吐，由上腰三角突出9例，由下腰三角突出1例。10例均经多普勒超声协助诊断。10例均行手术治疗，3例利用自身组织缝合修补，7例使用人工补片修补。结论临床表现和体征是诊断腰疝的关键，彩色多普勒超声是腰疝首选的辅助诊断方法，外科手术是治疗腰疝的有效手段。     

Repair of lumbar incisional hernia using polypropylene mesh strip sutures – A case report

IntroductionLumbar hernias are considered rare and they constitute less than 1.5% of all abdominal wall hernias.Case reportHere we present a case of a 72-year-old female with a left flank swelling since 2-years diagnosed as a lumbar incisional hernia. This lumbar incisional hernia¹ was repaired successfully using polypropylene mesh strip sutures.²DiscussionMany surgical techniques have been described for repair of LIH. Suture repair, mesh repair and myofascial flaps have been described for lumbar hernias. Repairing a lumbar hernia can be surgically challenging because of its proximity to bony structures, which can limit proper dissection and mesh overlap. We performed defect closure with PMSS. Patient has no recurrence after 2 years of follow up.ConclusionIn our case of left lumbar incisional hernia, defect closure with PMSS was an effective operation. This technique may also be effective in potentially contaminated settings due to reduced implant load. Further studies are required to understand its biomechanics and long-term outcomes.     

Laparoscopic tension-free hernioplasty for lumbar hernia

Lumbar hernia, a defect of the posterior abdominal wall, is a very rare condition. The repair of a posterior abdominal wall hernia by simply closing the hernia port with sutures may not be adequate, especially when the herniation is due to a weakness in the abdominal wall. Recently, a simple, logical method of tension-free repair has become a popular means for the treatment of various abdominal wall hernias. Previous studies have advocated the use of tension-free repair for lumbar hernia; the technique uses a mesh replacement and requires an extensive incision. Herein we present a case of superior lumbar hernia. Our technique consisted of a laparoscopic tension-free hernioplasty with the application of a Prolene mesh. This technique, which provides an excellent operative view, is safe, feasible, and minimally invasive. We conclude that laparoscopic tension-free repair should be the preferred option for the treatment of lumbar hernia.     

腰椎间盘突出与神经根出囊位置的关系

通过对１０具尸体标本和２００例腰椎管造影观察，明确了腰神经根出囊位置的特点。在此基础上，分析了１２４例经手术证实的侧方型腰椎间盘突出与神经根出囊位置的关系，将神经根受压类型分为腋下、肩前和肩上三种。并通过影像学检查和临床定位体征检查的比较，探讨这二种检查方法诊断符合率差异的原因。     

Lumbar hernia after breast reconstruction

INTRODUCTIONLumbar hernia is a rare complication that can occur after breast reconstruction using a latissimus dorsi flap. The defect occurs within the superior lumbar triangle and may result in visceral incarceration.PRESENTATION OF CASEWe report a 61-year-old female who presented with a left sided lumbar bulge and pain 7 years following a modified radical mastectomy and latissimus dorsi flap reconstruction. Computed tomography demonstrated a lumbar hernia with incarcerated colon. The patient underwent a successful laparoscopic repair with prosthetic mesh underlay.DISCUSSIONLumbar hernias may be congenital, secondary to trauma or prior surgery. Imaging studies assist in excluding soft tissue tumors, infections, hematoma or abdominal wall denervation atrophy, which may also present as a lumbar bulge. Repair may be performed in an open, laparoscopic or retroperitoneoscopic approach.CONCLUSIONLaparoscopic lumbar hernia repair with mesh is a safe and feasible way to manage an uncommon complication after breast reconstruction with a latissimus flap.     

A different type of congenital lumbar hernia associated with the lumbocostovertebral syndrome

Congenital lumbar hernia is rare in infancy and childhood, and its association with the lumbocostovertebral syndrome is even more unusual. Only 20 cases have been reported in the English literature. We present the case of a child with multiple costovertebral anomalies, undescended testis, and lateral abdominal wall hernia that is not within the anatomical boundaries of traditional lumbar hernias.     

Incisional lumbar hernia after the use of a lumbar artery perforator flap for breast reconstruction

Abstract

Autologous breast reconstruction with a perforator flap has become increasingly popular. The free lumbar artery perforator (LAP) flap has been described as a good alternative for autologous breast reconstruction. The LAP flap is a perforator flap based on a single pedicle. This flap is easy to harvest, with minimal donor-site morbidity. We present a case of a lumbar incisional hernia after LAP flap breast reconstruction in a 53-year-old patient. The patient had been treated with a bilateral mastectomy for cancer. Secondary breast reconstruction was performed with a bilateral DIEP flap. Reoperation was necessary because of a failed DIEP flap at the left side. Reconstruction was performed with a free LAP flap. The patient was referred for a right lumbar incisional hernia at the donor-site of the LAP flap. Open repair was performed with a retroperitoneal mesh. The thoracolumbar fascia was closed in with a running suture. Lumbar artery perforator is a perforator flap based on a single pedicle. Although it does not sacrifice any muscle and seems to be associated with minimal donor-site morbidity, we present the first report of a lumbar incisional hernia repair after LAP flap breast reconstruction treated using an open retroperitoneal mesh repair.     

经皮穿刺髓核成形术治疗腰椎间盘突出症初步临床报道

目的　寻求一种简单、安全、有效、微创的椎间盘突出症治疗方法。方法　对 1 6例腰椎间盘突出症采用经皮穿刺髓核成形术 (Nucleoplasty)治疗 ,并对其疗效进行观察分析。 结果　全部患者经二周至一个月短期随访 ,症状均有不同程度改善 ,疗效优良率为 93 8% ,有效率为 1 0 0 %。未发现明显并发症。结论　髓核成形术是一种先进、安全、有效的椎间盘突出微创手术 ,具有操作简单、安全、微创、疗效佳、恢复快、无需住院等优点。